Ekrem AKSU, Abdullah SÖKMEN, Gülizar SÖKMEN, Fatma Betül GÜZEL, ADEM DOĞANER, Özkan GÜNGÖR

Association of Fragmented QRS Morphology With Risk of Atrial Fibrillation in Hemodialysis Patients

Objective: Atrial fibrillation (AF) is the most common form of arrhythmia in hemodialysis (HD) patients. Fragmented QRS (fQRS) morphology has been proposed as an ECG marker to predict the risk of paroxysmal AF in various conditions. In this study, we aimed to investigate the association between risk of AF development and P dispersion (Pd) and fQRS morphology in HD patients.Methods: After analyzing the 24-hour Holter recordings of the patients, they were divided into 3 groups as without atrial runs (WAR), short atrial runs (SAR), and silent paroxysmal atrial fibrillation episode (SPAFE). In ECGs taken before HD, the presence of fQRS morphology was investigated, and Pd was measured.Results: As a result of the analysis of the 24-hour Holter ECG recordings, it was determined that 12 of the 74 patients had SAR, while 6 had SPAFE. The duration of hemodialysis was significantly longer in the SPAFE groups than the WAR group (p=0.026). It was found that fQRS morphology could be an independent predictor of SAR (odds ratio=0.056; 95% CI, 0.006–0.548; p=0.013). The incidence of fQRS morphology was significantly higher in the SPAFE group than the WAR group (p=0.002). However, this significance did not continue in the multivariate analysis. Pd was similar between the groups.Conclusion: This retrospective study is the first study that investigated the association of fQRS morphology with SAR and SPAFE in HD patients, and it showed that fQRS morphology may be useful in distinguishing HD patients with a high AF risk.

Hemodiyaliz Hastalarında Fragmente QRS Morfolojisinin Atriyal Fibrilasyon Riskiyle İlişkisi

Amaç: Atriyal fibrilasyon (AF), hemodiyaliz (HD) hastalarında en sık görülen aritmi şeklidir. Çesitli durumlarda paroksismal AF riskinin tahmininde bir elektrokardiyografi (EKG) belirteci olan fragmente QRS (fQRS) morfolojisi önerilmiştir. Bu çalışmada HD hastalarında AF gelişme riski ile P dispersiyonu (Pd) ve fQRS morfolojisi arasındaki ilişkinin araştırılması amaçlanmıştır. Yöntemler: Hastalar 24 saatlik holter kayıtları inceledikten sonra çalışma grubu atriyal atak olmayan (WAR), kısa atriyal atak (SAR) ve sessiz paroksismal atriyal fibrilasyon epizod olan (SPAFE) olmak üzere 3 gruba ayrıldı. HD'den önce alınan EKG'lerde fQRS morfolojisinin varlığı araştırıldı ve Pd ölçüldü. Bulgular: Hastaların 24 saatlik Holter EKG kayıtlarının analizi sonucunda 74 hastanın 12'sinde SAR, 6'sında SPAFE saptandı. Hemodiyaliz süresi SPAFE gruplarında WAR grubuna göre anlamlı derecede daha uzundu (p = 0.026). fQRS morfolojisinin SAR için bağımsız bir prediktör olabileceği bulunmuştur (olasılık oranı = 0.056;% 95 GA, 0.006-0.548; p = 0.013). fQRS morfolojisi insidansı SPAFE grubunda WAR grubuna göre anlamlı olarak yüksekti (p = 0.002). Ancak, bu önem çok değişkenli analizde devam etmemiştir. Pd gruplar arasında benzerdi. Sonuç: Bu retrospektif çalışma, HD hastalarında fQRS morfolojisinin SAR ve SPAFE ile ilişkisini araştıran ilk çalışmadır ve fQRS morfolojisinin AF riski yüksek olan HD hastalarını ayırt etmede yararlı olabileceğini göstermiştir.

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